Why people get an Acute Heart Failure?

There may be one or sometimes several factors causing acute heart failure.

In order to understand easily, we would like to divide the causes of heart failure into two main categories:

1. Damaged or weakened heart muscle or Valves:
   This is the commonest and the conditions causing this includes:
1. Heart Attack (Myocardial infarction)
2. Sudden deterioration of heart valves
3. Severe Coronary artery disease
4. Myocarditis (inflammation of heart muscle)
5. Sudden deterioration in Heart rhythm
2. Stiffness of the heart muscle without damage:
   In this condition, the heart doesn’t relax after each pumping action and therefore, unable to push blood effectively. Usually caused by acute severe Hypertension (significantly uncontrolled high blood pressure).

Risks for an Acute Heart Failure

1. Several cardiovascular and non-cardiovascular health conditions may cause a sudden (rapid) development or deterioration of heart failure leading to hospitalization.
2. The possible heart Conditions contributing to acute heart failure includes: Acute coronary syndromes, Bradycardias ( slow heart rate), Acute pulmonary embolism (clots in the lungs).
3. The possible non-cardiac caused include: infections, Anaemia, Hyperthyroidism, Hypothyroidism and not taking his heart failure mediations ( poor compliance with medications.)

How to diagnosis an Acute Heart Failure (Emergency)

1. The symptoms of acute heart failure starts suddenly or abruptly. The symptoms of acute heart failure usually depends on the underlying heart problems. This is usually caused by the Acute heart attack, arrhythmias, faulty valves.
2. The patient may present in various stage of un-stability including, Severe Breathlessness with or without low blood pressure.
3. Some may present with Cardiogenic shock ( heart unable to pump blood) and the patient may need support for lungs ( Intubation)
4. The doctor on clinical features and some investigations makes the diagnosis.

Treatment of an Acute Heart Failure

The steps to follow are:

1. Step 1: Call for ambulance or Go to the nearest Hospital
   if you have the following symptoms, which starts suddenly:
1. Moderate to severe Shortness of breath and may have Nausea, cold clammy and Sweating or Dizziness.
2. Coughing up pink, foamy mucus
3. Chest pain or chest discomfort may be mild or severe. ( if due to Heart attack) usually on the left side of upper chest/left arm or neck/jaw)
4. Some people may have their heart stop immediately (sudden cardiac arrest)
2. Step 2: Doctor in hospital will do:
1. The doctor will take a detailed history of your symptoms and do physical examination.
2. Do and Urgent ECG/EKG
3. Additional tests may be required ( Bloods, Chest X-ray, Urgent scan- Echocardiogram)
3. Step 3: Doctor Will Make diagnosis and decide for treatment
   Once the doctor confirms the acute heart failure, the aim is to:
   
   “Quickly restore the blood flow to the heart muscle (if heart attack) and remove the excessive fluids from lungs (pulmonary oedema), in order to save the heart muscle from damage”.
   
   The steps are as follows:
1. Will be attached heart monitor/ Blood pressure monitor and ECG/EKG.
2. Oxygen may be given via Mask OR pressurized machine.
3. Pain relievers with morphine or other medications.
4. Blood-thinning medications called heparin
1. Heparin make your blood less "sticky" and stops clots formation.
2. Heparin is given intravenously or by an injection under your skin
5. Clot-preventing drugs. (Anti-platelet medications)--- IF heart attack
6. Furosemide: medications to remove water from the lungs. Given via IV line
7. Nitrates: Given to remove water from lungs. Given via IV line
8. Inotropes. These are live saving medications given in severe heart failure in order to improve heart pumping function and maintain blood pressure
9. Heart support devices; if patient is unwell, may need additional heart devices including; Intra-Aortic Balloon Pump, ECMO, Impella mechanical support.
4. If doctor confirms a heart attack then the doctor will follow the treatment.
1. Treatments for Opening the Complete Blocked Artery
2. Treatments for Opening the Partially Blocked Artery (NSTEMI)

How to live with Angina?

The duration of total stay in hospital varies from 3 days to 1 week. This usually depends on the amount of damage your heart has sustained and your adjustments to various medications.

1. After the initial emergency treatment (as above), you will be admitted to coronary care unit or cardiology ward, where will you will be monitored closely and looked after specialized trained team of doctors and other medical staff.
2. You will undergo various investigations in hospital including:
1. Electrocardiogram (ECG or EKG)
2. Blood tests: including heart chemicals ( Troponin)
3. Echocardiogram

How to live with acute Heart Failure?

Diet and Life style changes:

If you had a acute Heart Failure, you must work on your lifestyle changes: these changes include:

1. Stop smoking and avoid exposure to passive smoking.
2. Eat a healthy diet with limited amounts of saturated fat; eat whole grains, and many fruits and vegetables and Restrict sodium in your diet
3. Treat diseases or conditions that can increase your risk of angina, such as diabetes, high blood pressure and high blood cholesterol and stress.
4. Limit alcohol consumption to one to two drinks or fewer a day.
5. Maintain a healthy weight and maintain weight monitoring diary

Cardiac Rehabilitation:

1. Very important program run by doctors and medical team to help you recover from your heart failure.
2. Cardiac rehabilitation programs generally focus on four main areas — medications, lifestyle changes, emotional issues and a gradual return to your normal activities.
3. The above changes will be tailored according to your individual needs and the amount and severity of heart failure.

Heart Failure and Driving:

1. You can drive after 4 weeks following acute heart failure and recovery
2. You must inform your licensing authority and get advice if you drive large goods vehicles (LGV) or passenger-carrying vehicles (PCV).

Heart Failure and Working:

1. After about 4-6 weeks you can usually go back to your work.
2. If your job involves heavy lifting or manual laborer, discuss with your employer.

Heart Failure and Sexual Life:

1. Most people can safely return to sexual activity after recovery but usually depends on your physical comfort, psychological readiness and previous sexual activity.
2. Some heart medications can affect sexual function. Your doctor can then prescribe alternative medications particularly beta blockers (consider Ivabradine).
3. You should NOT use Viagra if you are on regular nitrates tablets.

Getting Support

Heart failure and support services

Having a heart failure is one of the scariest experience of your life.

People may experience Fear, anger, guilt and depression after a heart failure.

Discussing them with your doctor, a family member or a friend might help. Or consider talking to a mental health provider or joining a support group.

Please refer to online support groups such as:

British Heart Foundation (BHF)

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